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Prof. Michael Baum: Targeted Intra-operative Radiotherapy —
Targit for Early Breast Cancer

Can we spare the patient’s daily journeys to the radiotherapist?

Breast conservation by wide local excision for early breast cancer is now considered safe and should be considered default therapy wherever possible.

Unfortunately this all depends on access to costly radiotherapy centres.

Many women in the developing world or for that matter in wealthy countries with large land masses and small populations don’t have access to radiotherapy and are therefore denied the option of breast conserving surgery.

Whole breast radiation by external beam after wide local excision of the tumour is predicated on the belief that latent foci of sub-clinical cancer outside the index quadrant are responsible for local recurrence. We do not think this is the case as over 90% of these recurrences occur in the index quadrant. I will describe a novel system for intra-operative radiotherapy using a mobile unit that should, in theory, be able to replace 6 weeks of external beam from a linear accelerator. The technique, TARGIT, is currently undergoing a multinational clinical trial in comparison with conventional external beam. If we can prove at least equivalence in outcome then breast conserving surgery might become available to all women in the developing world or for those living long distances from the nearest radiotherapy centre in addition to sparing our own patients 5-6 weeks of daily treatments.